Linda J. Clark, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

18002119 Issued in IN

Legal business name

LINDA J. CLARK, O.D.

Practice address

1765 Stafford CT
Goshen, IN 46526-6542

Phone

(574) 533-4910

Fax

(574) 534-3479

NPI assigned

Jun 18, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Linda J. Clark, O.D.

Title

Owner

Phone

(574) 533-4910

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1245283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245283200000",
    "number": "1265669170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1765 STAFFORD CT",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465266542",
            "telephone_number": "574-533-4910",
            "fax_number": "574-534-3479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1765 STAFFORD CT",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465266542",
            "telephone_number": "574-533-4910",
            "fax_number": "574-534-3479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LINDA J. CLARK, O.D.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-18",
        "last_updated": "2009-06-18",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "574-533-4910",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18002119",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Goshen, IN
• Providers in Goshen, IN by specialty
• Optometrist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.